Peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a rare cardiac disorder of unknown cause that occurs in pregnant females, most commonly in the early postpartum period. It shares many clinical characteristics with idiopathic dilated cardiomyopathy but occurs at a younger age and is associated with a better prognosis. The etiology and pathogenic mechanisms have been difficult to study, however current hypotheses include infectious, immunologic, nutritional, and iatrogenic causes. Diagnosis is based upon the clinical presentation of congestive heart failure and objective evidence of left ventricular systolic dysfunction. Mortality rates over the past 10 years in PPCM have decreased, most likely due to advances in medical therapy for heart failure and use of implantable defibrillators. For those patients, who remain refractory to conventional pharmacologic therapy, cardiac transplantation and mechanical circulatory support are viable options. In less than 50% of PPCM patients, left ventricular function normalizes with pharmacologic therapy. However, subsequent pregnancies are often associated with recurrence of left ventricular systolic dysfunction.